With Julie Belton, Director of Cuckloo Lane Health Practice, Ealing, London

For more than 6,500 patients in the west London borough of Ealing ‘going to see the doctor’ hasn’t been part of their language for more than a decade.

For this portion of a diverse community where half of the population is from the BAME community (Black, Asian, Minority Ethnic) going to see ‘the nurse’ is how they see primary care, their care.

That is because these patients are clients of the UK’s only nurse-led practice, where nurses are in charge.

Cuckoo Lane Health Practice is completely unique, and according to Director Julie Belton, can be and should be copied elsewhere. It just has not been yet.

Her fellow director Carol Sears made a unique decision 15 years ago when the GP she worked with retired, and the practice went to tender. She and two colleagues – a fellow nurse and a practice manager – put in a bid….and won.

Julie, a trained nurse and a trained midwife, joined five years later as a director (having added a string of new qualifications to her CV including a Masters in Individual and Organisational Development).

“We are mavericks,” says Julie. “Even today so many years later there will be some GPs out there who aren’t happy with what we did and what we have grown to become.

“What we have done is that the nurses in our practice work to the edge of their qualifications. We hire in a GP for two to three hours each day but 80 per cent of our patients are seen and treated by nurses, we do the prescribing and look after them.

“The GPs we work with are very happy with the arrangements too. They get to do what they’re good at without the worry of running a practice and all the paperwork that goes with it.”

Staff of Cuckloo Lane Health Practice

Julie says the success of the practice (it has been quality assured as Outstanding in one inspection) is based on their model of care and the way staff come together.

“We operate a flat structure of leadership, so we don’t have a hierarchy. We look after our staff, pay them well and communicate with each other regularly. We respect each other and there is a great rapport among us,” says Julie.

The practice has six nurse practitioners, three practice nurses, two healthcare assistants and administration and reception staff. Many staff work part-time so the Cuckoo Lane team meets twice every day for a five-minute, five-point huddle where everyone has their say. Everyone is in the loop.

“Patients are also – as far as possible - encouraged to make their own decisions on their own care. We go above and beyond the call of duty for each one of them.”

But isn’t there a culture among patients? Those who just must see a doctor? Julie says it doesn’t happen at Cuckoo Lane.

“We don’t have any issues with patients who insist on seeing a GP every time they have to come in to see us. They know us and trust us,” she says.

Julie and her team are keen to spread their knowledge further; to create more ‘mavericks’ in healthcare. So Cuckoo Lane takes in medical students on placements.

“Our undergraduates love it here. They get to see how far their careers can go and they get to see leadership roles they can aspire to,” says Julie, who in February was one of the few nurses in Britain directly in charge of a Covid-19 vaccination centre. She was placed on a roster alongside GPs from other practices in Ealing.

This ‘maverick’ wishes that more nurses in her profession would follow in her and Carol’s footsteps.

“I’d advise anyone thinking of following our model of care to explore it, build a team, build a strategy, foster that team and communicate with them. It can be done,” she says.

You can find out more about the practice on its website (available in 99 languages including Irish) or follow the Cuckoo Lane team on Facebook and Twitter.